Friday, November 5, 2010

Knee Pains

Hello everyone,
Happy Moon Day! Whether you observed the Moon Day today, are going to observe it tomorrow, or even if don't observe Moon Days at all, I hope this day brings you some well-deserved rest.

I thought I'd take advantage of this little break from our daily ashtangic grind to broach a somewhat sensitive topic: Pain and injury in the practice. Specifically, I'll like to discuss knee pain and injury, and hopefully get your opinions on this issue.

I would like to be able to say that I have never experienced any pain or injury in my ashtanga practice before, but that would be disingenuous. Over the years, I've had my share of pains and injuries (SI joint misalignments, knee tweaks, rotator cuff issues, to name a few...) I'll also admit that I do not always have the best or wisest injury-rehabilitation plans. For example, during the early days of my practice, I once endured a rotator cuff injury for a few months straight, and did all the usual postures without any modifications, even though just doing even basic postures like downward dog caused the rotator cuff to hurt like hell. Yes, it was my ego...

But all this is neither here nor there. I have a responsibility to you, my fellow blogosphere inhabitants, not to squander your attention, so I'll get to my point. So, back to knee pain and injuries. I don't think it is an exaggeration to say that knee pain and injuries may be the single most common issue facing ashtangis in the course of the physical practice. I have never practiced at a place where no one is working with knee issues. I have also noticed that over the years, from practicing with different teachers and practitioners, I have noticed that yogis and yoginis can be broadly divided into three groups when it comes to their views on dealing with knee pain and/or injury:

(1) The Yoga Journal Politically Correct/Conservative group: Practitioners in this group view the slightest discomfort or tweakiness in the knee as a sign to back off doing any posture that might place the slightest pressure on the knee joint, or any of its connecting ligaments or tendons. So, if you belong to this group, the slightest "off" sensation in the knee would be interpreted as an immediate signal to not do padmasana, half-padmasana, virasana, half-virasana, or any of their variations.

(2) The Yoga Journal Politically Incorrect/ Somewhat-Aggressive-Approach group: So-called because such a view would never make it to the pages of Yoga Journal. At least, I can't imagine Yoga Journal endorsing this view. People in this group will continue to do padmasana even if they have to endure pretty intense knee pain in so doing. This is probably a very unorthodox view in the yoga community, but I do know people who belong in this group. For example, my teacher told me that when he first started doing padmasana, his knees hurt for an entire year. But he endured, and somewhat managed to continue doing padmasana to this day without blowing his knees out.

(3) The Middle-of-the-Road group: People in this group think that there are limitations in the views of both groups (1) and (2). If you follow the approach of group (1), and simply avoid all knee postures (padmasana, virasana, or their variations) at the slightest sign of knee pressure, then your body might never learn to open up sufficiently to get into these postures. Which leads to a kind of chicken-and-egg paradox: You can't do padmasana because your hips are not open enough, but your hips are not open enough because you never try to work at padmasana. But, on the other hand, if one follows the approach of group (2), and just pushes into padmasana, there is a very real risk that serious damage may ensue. So, the middle-of-the-road-group proposes that one should find ways and means to do padmasana (or half-padmasana) that bring the knees to the edge, to the point just before discomfort becomes pain. The idea is that if you come to this point regularly, you will be able to "persuade" the hips to open up over time, and eventually get into a fuller and deeper padmasana. At her workshop, for example, Kino suggested something along these lines: If one has knee issues, one can try getting into half-padmasana by first bringing the foot to the thigh in a seated position (just like if you were getting into Marichyasana A). This closes the knee joint and immobilizes it, protecting it from instability. Then, keeping the knee joint closed, one slowly brings the foot to rest as high on the opposite thigh as possible without feeling pain. The idea is that, over time, the hip rotator will open up enough to allow the foot to snuggle deeper into the thigh and the abdomen, leading to a progessively deeper half-padmasana.

In representing the three views above, I try my best to remain detached, and to not take sides with any one view. I'll also admit that these three views are probably a little simplistic: It is quite possible that most people do not fit neatly into any one of these views, but either subscribe to some mix of these three views, or alternate between them. But I thought this is a start to getting us to think and discuss this issue.

One more disclaimer: If you are big Yoga Journal fan, I apologize for making a caricature of your beloved publication. If you want to throw metaphorical peanuts or eggs at me, go ahead. I hope my Jedi powers would be powerful enough to enable me to dodge all your projectiles :-) May the Force be with me.

But seriously, I would like to hear your views about this issue that, I suspect, has caused (and is still causing) much angst and frustration among ashtangis.

9 comments:

Hi , great post, I normally take the middle road path too, I try to find the edge but never push. In my particular case indo not have meniscuses due to two operations where they removed them (knees were locking) way before I started ashtanga... So for me to get into the lotus was a long project (even Manju saidnto me he doubted I could get in it in 2007), so when I finally did it right after lots of adjustments and suggestions from John and Eddie, it was cause for celebration. I suppose I am lucky, that operation has made me very aware of the value and fragility of the knees, so I respect them!

My knees hurt the entire first year of my practice. I thought to myself that I had started too late in life and was to heavy, and those were the cards I had been dealt. One day the pain just went away. When I say pain, I probably mean soreness. I think everyone must get familiar with the part of the knee that won't budge even after your best effort. You know that a surprised "OUCH" comes right after having gone past that point, so let's not go there.

Thanks for sharing, Claudia. Very inspiring. Your experience reminds me of something that Eddie and Nicki said about the practice: It makes the impossible possible. With patient work and consistent practice, things that we consider impossible in our bodies can become possible. Again, the words of Guruji: Do your practice, and all is coming.

Your experience brings to mind a less dramatic experience of my own. I still remember the very first time I got into padmasana, about 6 months after I first started practicing. It wasn't a deep padmasana, but there was something about getting into the pose that made me smile. To this day, I still don't know whether I smiled because I felt happy at getting the pose, or because of some mysterious energy that had been unlocked from the base of my spine (not to get too mystical here, but I just can't help wondering...)

Very interesting, Kai. I suspect that many teachers probably adopt the same policy as you do, probably because they don't want their students to inadvertently push too much or too far in their practice, and hurt themselves. I wonder if that might also explain the Yoga Journal view as well; maybe they don't want to be held liable for injuries and such? But I wonder if that waters down the yoga experience for many practitioners? After all, we know that pain/discomfort comes in a few different categories, and part of being a skilled asana practitioner (at least for me) lies in not avoiding pain or discomfort altogether, but in navigating the tight rope between constructive pain and debilitating injury. Just wondering...

fft, thanks for sharing. I wonder if that was the same kind of experience my teacher was going through when he said his knees hurt for an entire year. He used to be a martial artist, and the pain probably came from old martial arts injuries. I'll like to ask you a somewhat personal question, if you don't mind: What was it that made you continue to practice that first year through the pain? I've heard so many people tell me stories of how they freaked out and gave up the practice because of pain in various parts of their bodies. So I'm wondering what it was that made you continue to practice? Would you like to share with us? But if you think this question is too personal, I totally understand.

I was a #2 when I started Mysore-style Ashtanga a year ago, but quickly moved to #3. I've never had any problems with my knees or with padmasana except for one practice after a break where I was too enthusiastic in the half-lotus poses, leaving me with sore menisci for a week. My approach to pushing through pain changed after that.

I've had a very similar experience to Danielle, and to Five Foot Two. I have never gotten lotus because of tight hips and already wonky knees, and I was older when I started the practice, but I wanted to do it so badly that I sort-of jammed my left leg (which is the more open side) into lotus for a couple of weeks, thereby mashing my meniscus. And now I can't do it at all. I found the break point to be when I limped and was woken up in the middle of the night with knee pain. I suppose the line is different for everyone. So, I have found #2 to be a counterproductive approach. I am working slowly, slowly on being able to get both legs there. I've been practicing about a year; I have no idea how long it will take me to finally achieve padmasana, but I do know that I will have a HUGE smile when I do!

I'm having knee discomfort issues right now, so I guess I will go easy in my half lotus poses in class (even though I was still experimenting with them at home this afternoon) :( It's hard for me to distinguish harmless discomfort from injury-warning pain because I associate the concept of pain with a sharp sensation that would induce reflex avoidance rather than a feeling that makes me ponder whether or not to back off from a pose.

Greetings!

Welcome to Yoga in the Dragon's Den. I am very happy that you take the time to visit and read my posts. I will be even more happy if you comment on my posts :-) I love comments: I think they are a wonderful way for me to engage in conversation with you. If you do not feel comfortable commenting, and would rather get in touch with me personally, you can also email me at siegfried23 at hotmail dot com

Namaste, and May the Force be with You.

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It's so hard to describe yourself without putting yourself into boxes or categories, but I'll try. At present, I practice ashtanga yoga, teach philosophy at a university, and try my best to make as much sense as possible of my life and things around me, in pursuit of the answer to life's mysteries: big, small, and everything in between. What if there are no answers? Well, then maybe the fun is in the searching...